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					                                                         Kathryn H. Thompson, Ph.D.
                                                                    April 11, 2001

                      Prenatal Nutrition and Lactation


Objectives

   To produce a healthy, normal weight infant while minimizing the short and
    long term health risks to the mother

   To determine the appropriate weight gain during pregnancy for the normal
    weight underweight and overweight pregnant woman

   To recognize the additional energy, vitamin and mineral requirements during
    pregnancy and lactation

   To recommend dietary modifications to help alleviate nausea, heartburn and
    constipation during pregnancy

   To develop skills to help promote and maintain breast-feeding




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                               Prenatal Nutrition


I.      Questions with nutritional implications for the obstetric history

     and physical exam


     A. Present illness


        1. General: recent weight change, poor weight gain, edema, dehydration


        2. G.I. complaints: Diarrhea, nausea, vomiting, heartburn, constipation


     B. Medical History


        1. Prenatal vitamins, nutritional supplements, herbs, remedies?


        2. Iron supplements/


        3. Food allergies


        4. Non-food cravings


        5. Obstetric history


     C. Social History


        1. Alcohol?


        2. Special Diet?




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   3. How many meals and snacks daily?


   4. Avoid any specific foods?


   5. Milk: how much, type?


   6. Lactose intolerance


D. Family History


   1. Familial occurrence of dx


   2. History of children with fetal anomalies


E. Review of symptoms


   1. General: Fatigue, weight change


   2. Month: teeth, gums, lips, tongue


   3. GI/abdomen: Appetite, food intolerance, nausea, constipation, diarrhea


F. Physical Exam


   1. Anthropometric data


      a Height


      b Current weight




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         c   Prepregnancy weight


         d Prepregnancy BMI


         e Weight gain during pregnancy so far


  G. Laboratory Evaluation


      1. Glucose


      2. Hematocrit


      3. Hemoglobin


II.   Maternal weight gain


  A. Underweight


      1. BMI < 19.8


      2. Total weight gain 28 - 40 lbs.


      3. 5 lbs./ 4 weeks


  B. Normal


      1. BMI = 19.8 - 26


      2. Total weight gain 25 - 35 lbs.




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      3. 4 lbs./ 4 weeks


  C. Overweight


      1. BMI = 26.1 -29


      2. Total weight gain 15 - 25 lbs.


      3. 2.6 lbs./ 4 weeks


III. Nutritional requirements


  A. Energy: + 300 kcal in 2nd and 3rd trimester


  B. Protein: RDA = 60 g


  C. Calcium


  D. Folate


  E. Iron


IV.   Nutritional Problems

  A. Nausea and vomiting

  B. Constipation

  C. Heartburn




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